Study
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Study Population
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Study Design
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Curriculum Design
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Empathy Topics Addressed
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Primary Outcome (Effect size and P value where available)a
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Quality Assessed (MERSQI)b
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Albertine S. Beard, 2020
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N:10
Level of training: Third Year
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Controlled Trail
2 groups
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Modality: Longitudinal Integrated Clerkships – VALUE
Frequency/Duration:
10 months
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A respect for a patient’s values and preferences /a clear patient physician communication/A well-coordinated care
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Patient outcome- A greater sense of satisfaction reported by VALUE patients with their health care providers in terms of explanations provided, knowledge of patients’ history, and their best interests (P < .05)
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16.5
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Lauren Collins, 2020
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N: 45
Level of training:
Third and fourth year
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Controlled Trial
(control-no intervention)
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Modality: Student Hot spotting/ IPE/ Apprenticeship/Supervision
Frequency/Duration:
6 months
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Patient centred approach/Partnership for a personalized self-management plan
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Knowledge:
ATHI, JSE; A higher post-test score in terms of self-efficacy and empathy (participants
Vs controls) (P=.05).
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10.5
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Elizabeth Davison, 2019
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N: 170
Level of training: First Year
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Single group, post-test only
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Modality: Student supervision by an HCA* mentor in an early clinical exposure curriculum
Frequency/Duration:
3 days
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Incorporate human values
while underpinning Interprofessional practice (IPP)
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Self-report:
Reflections narrated more able to empathize, better equipped and confident and appreciate IPP.
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11
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Leanne M. Chrisman-Khawam, 2019
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N: 64
Level of training: Undergrad students
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Single group, post-test only
(qualitative)
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Modality: Service-learning experience – student run free clinic – socialization -mentorship - reflective
practice
Frequency/Duration:
Weekly winter season clinics
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Model of patient-physician
Relationships/Interprofessional relationships/Professional identity formation
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Self-report: More introspective and a sense of connection to patients on a human level.
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NA
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Prima Cheryl D’souza, 2019
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N: 82
Level of training: Second Year
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RCT
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Modality: Didactic PowerPoint, video clips, and roleplay and simulation
Frequency/Duration:
Single session -2 hours
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Empathetic communication
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Self-report:
JSE: A difference in empathy score (control vs intervention) (p = 0.014) with a decline at 3-week follow-up (p = 0.020)
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12
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Hitomi Kataoka, 2018
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N: 69
Level of training:
Year 1-6
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Single group, pre and posttest
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Modality: Didactics case-based discussions; simulation with standardized patients, feedback provisions
Frequency/Duration:
Three 4-hours workshops over a period of two years
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Communication skills and medical interviewing
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Self-report:
JSE: An immediate significant increase (SD=10.0) in post-test mean score (p<0.0001), however, the mean score bounced back to the pre-test level in year 5 (SD=12.9) and year 6 (SD=13.8)
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10
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Anita Modi, 2017
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N: 188
Level of training: First to Third Year
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Controlled Trial
(control- no intervention)
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Modality: Service learning experience – student run free clinic – socialization -mentorship
Frequency/Duration:
Weekly student run clinics over a period of 3 years
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Early and consistent exposure to poor and underserved
Patients – hidden curriculum – implicit to explicit
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Self-report:
JSE: A drop in mean empathy scores for both volunteers (2.2 points) (P = 0.07, effect size =0.20), and non-volunteers (3.1 points) (P = 0.009, effect size >0.25).
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10
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Antonio T. Fernando, 2017
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N: 83
Level of training: Third Year
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RCT
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Modality: Didactics - Mindfulness based exercises – Simulation – Role play
Frequency/Duration:
2 hours single session
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Emotions and clinical decision making/Self-compassion/Mindfulness/speech on civic service
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Behaviors; Objective: A varying fluctuations of time allocated to each patient by participants with lower self-compassion vs a consistent time allocation to each patient by persons with high self-compassion.
Self-report:
SCS, MCSF-C, TMS, B-DES, VAS - Mindfulness led to an increased patient liking and caring in persons with lower self-compassion vs a greater helping behaviour in persons with a higher self-compassion. A promising enhancement of compassionate responses in medical students after a brief mindfulness induction (P<0.05)
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15
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Celine Buffel du Vaure, 2017
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N: 299
Level of training: Fourth Year
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RCT
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Modality: Simulation of interpersonal problems - Balint group
Frequency/Duration:
7 weekly sessions over a period of 2 months
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Solution to interpersonal problems during physician patient interaction.
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Patient outcome:
CARE : Non significant difference in mean CARE score (Intervention vs control groups) (P= 0.49).
Self-rate-JSE: An increase in score for intervention vs a decrease in score for control from baseline to follow-up [P= 0.031].
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16.5
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Ing Van Dijik, 2017
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N: 167
Level of training: First year of clinical clerkships (second/third year)
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RCT
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Modality: Didactic class room teaching
Frequency/Duration:
Eight weekly two-hour
sessions
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MBSR : Stress awareness and mindfulness: Communication, work life balance and recognizing boundaries
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Self-report- BSI, MHC-SF, LiSat-9, JSE, FFMQ, IBI,
MBSR group – a small reduction of psychological distress (P = .03) and
dysfunctional cognitions (P = .05), while a moderate increase of positive mental health (P = .002), life satisfaction (P = .01), and mindfulness skills (P = .05) vs CAU over a 20-month follow up. No significant change
on empathy (P =0.18).
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13
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Karen E. Smith, 2017
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N: 122
Level of training:
First Year – third year
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Single group pre and post-test
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Modality: Online surveys and computerized tasks
Frequency/Duration:
At start and end of each academic year for first
3 years of medical school
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Pain Visual Analogue Scales, being sensitive to others’
pain and how to understand others’ emotions, (video ratings of individuals expressions of pain and RMET)
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Behavior-
RMET; An significant improvement in accuracy in recognizing others’ emotional states, and a decrease in reaction time in longitudinal measurements
(p < 0.001)
Self-report- JSE score decreased over training (p < 0.01) while
QCAE revealed an improvement in different empathy components; cognitive (perspective taking,) and affective (emotion contagion) (p < 0.05)
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15.5
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M. Wundrich, 2017
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N: 158
Level of training: Third Year
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RCT
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Modality: Videos, simulation and OSCE
Frequency/Duration:
2 sessions (2.25 hours each)
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Physician–patient relationship, empathy skills and behaviours
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Patient outcome- by standardized patients and experts, significantly higher empathy score and ratings as compared to control group. (p < 0.05)
Self-report- JSE: no significant difference (p=0.13)
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16
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Marcello Schweller, 2017
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N:166
Level of training:
First Year
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Single group, pre and posttest
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Modality: Patients and physicians’ interviews, , role modelling, supervised hospital visits, analysis of videotaped simulated consultations
Frequency/Duration:
Weekly session over 4 months
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Health and Medicine (H&M): Professional identity formation by incorporating desired Vvlues and virtues
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Self report- JSE:
Improved mean empathy scores (117.9 vs 121.3) (p<.001.)
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9.5
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Roger Ruiz-Moral, 2017
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N: 115
Level of training: Third Year
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Single group, pre and posttest
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Modality: Multiple didactic, reflective, and interactive workshops and simulated patients encounters.
Frequency/Duration:
6 weeks course
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Contextual and emotional clues/empathetic response tailoring/communication process to identify the feeling produced by the empathetic responses.
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Patient outcome- Progressive improvements over longitudinal period of time spanning all the domain and skills of communications by both OE (32.4%) and SP (38.3%) (p < 0.001)
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13.5
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Suman P. Singh, 2017
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N: 93
Level of training:
Second Year
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RCT
2 tests (CDG and VSG) and1 control
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Modality: Low-Fidelity
Simulation
Techniques (Case
Discussions and a
Video Show), interactive lectures, video show and demonstration were used
Frequency/Duration:
4 sessions in a week (4.5 hours)
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Emotional, social and financial consequences of HAI on patients and their families
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Knowledge- significant change in knowledge test score
(p=0.016) among the groups
Self-report-
TEQ: significant difference in post-test
empathy scores among the groups (p=0.026).
CDG (p=0.011), VSG (p=0.046) had significantly better empathy scores vs control group
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12.5
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Adriana Foster, 2016
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N: 70
Level of training:
First year
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RCT
2 tests and 1 control
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Modality: online text-based interface for virtual patient (VP) interaction
Frequency/Duration: Single session
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Empathetic Communication and Feedback VP:
(1) Depression portrayed by control VP
(2) A VP with a simulation backstory of
patient shadowing, or
(3) An immediate empathy-feedback VP
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Patient outcome- StP ratings; A significantly higher scores on empathy-feedback and backstory VP groups vs control VP group (P < 0.0001)
Trained assessors: A promising response of students in eliciting empathetic opportunities in empathy-feedback VP group vs
backstory VP and control VP groups (P = 0.0005)
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17
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Alisa Alfonsi LoSasso[39], 2016
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N: 70
Level of training:
Third Year
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RCT
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Modality: Small group discussion of EMR use, the SALTED technique (Set-up, Ask, Listen, Type, Exceptions, Documentation),
and role-plays.
Frequency/Duration: 1 hour
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Training in EMR Specific Communication: empathetic engagement while history-taking and doctor patient interaction.
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Patient outcome-Significantly higher mean SP ratings for intervention vs control group (P = .05)
Self-report- JSE: Non significant change in mean empathy score for intervention (P = .57) vs control group (P = .41)
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16
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Eun Ho Yu, 2016
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N: 82
Level of training:
First and Second Year
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RCT
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Modality: Didactic
Frequency/Duration:
1-hour class
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Interpreting micro and subtle facial expressions
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Self-report- significant post intervention increase of mean METT (29.3% ) and SETT (36.2%) scores (P < 0.001)
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12
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Jennifer S. Mascaro, 2016
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N: 32
Level of training: Second Year
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RCT
(control-wait list)
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Modality: Didactic CBCT course, guided audio recordings, at home meditation practice
Frequency/Duration:
1.5 h once per week for 10 weeks.
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Compassion meditation protocol – stability of mind, insight to inner world of thoughts and feelings, self-compassion, equanimity, appreciation and gratitude cultivation, empathy and compassion for others
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Self-report-
CLHS; R-UCLA, DASS; PSS; SUI - increased compassion, decreased
loneliness and depression (paired t-tests, p > 0.05)
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11.5
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Jeremy Graham, 2016
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N:68
Level of training:
NR
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Controlled Trial (Control- no intervention)
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Modality: Didactic seminars, in class discussions, about films and art
Frequency/Duration:
10 in class contact hours in an elective course
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Humanities course: Sociocultural studies, history
of western medicine, and
visual arts and literature
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Self-report- JSE
Favourable empathy scores after humanities course (P=0.03)
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10
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Marlon Danilewitz, 2016
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N: 30
Level of training:
First and Second Year
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RCT
(Control-wait list WL)
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Modality: Medical student led peer program, homeworks
Frequency/Duration:
8, 1.15 hours weekly sessions
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Adapted MBSR program: Stress awareness and mindfulness: Communication, work life balance and recognizing boundaries
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Self report- DASS; JSE; FFMQ; SCS; AAS – MMP; a significant pre/post-test reductions in levels of stress (p=.019), increase in self-compassion (p=.024) and altruism (p=.033) and changes in two facets of mindfulness: describe (p=.05) and non-react (p=.034). Significantly higher MMP vs WL post-test scores on FFMQ (p=.026)
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11.5
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Meral Demiroren, 2016
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N: 190
Level of training: Fourth and Fifth Year
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RCT
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Modality: Small group case-based discussions, Guided written and verbal reflections Frequency/Duration:
2.5 weeks course
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Appropriate professional values and behavior; Patient-physician interaction
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Self-report- BMI; JSE; PSCOM-PQ; BPTI; a statistically significant impact of training on conscientiousness (p=0.003), openness to experience (p=0.033), compassionate care (p=0.018) and standing in the patient’s shoes (p=0.036); while students reported verbal reflections more beneficial vs written.
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13.5
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Pamela Tsao, 2016
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N: 25
Level of training:
First and Second Year
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Single group post-test only
(qualitative)
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Modality: Didactics, online study material, comic video recordings, in class guided written reflections and focus group discussions
Frequency/Duration:
4-hour single session
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Struggles of diabetes patient; how to bring behavioral change, reduce burnout, address fear of
insulin initiation, avoid guilt, curb denial and frustration with complications
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Self-report- Assessment of personal reflections revealed more empathy, better able to reflect and make meaning from work
JSE: mean JSPE scores baseline (116.4) and after watching comic videos, reflections (117.2) and focus group discussions (119.6)
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NA
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Pamela Duke, 2015
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N: 259
Level of training: Third Year
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Single group,
pre- and posttest
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Modality: Virtual hangouts - tutorials, small group discussion, reflections, blogs on VCR, LMS and SM
Frequency/Duration:
Virtual meetings every 8-12 weeks over 1 year
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Appropriate professional values and behavior; empathy and self-reflection
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Self-report- JSE no change in pre/post-test mean score, while a statistically significant increase in GRAS scores (p5<0.001)
Assessment of blogs highlighted that sharing of personal narratives
foster reflective ability and reflective practice.
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10.5
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