Personal and Contextual Factors Related to Empathy in Medical Students

161 Pages·2012·1.21 MB·English

THE CATHOLIC UNIVERSITY OF AMERICA

Personal and Contextual Factors Related to Empathy in Medical Students

A DISSERTATION

Submitted to the Faculty of the

National Catholic School of Social Service

Of The Catholic University of America

In Partial Fulfillment of the Requirements

For the Degree

Doctor of Philosophy

©

Copyright

All Rights Reserved

By

Deborah Camalier Walker

Washington, D.C.

2012
Personal and Contextual Factors Related to Empathy in Medical Students
Deborah Camalier Walker, Ph.D.
Director: Joseph Shields, Ph.D.
Despite the fact that research has emphasized the importance of empathy in the
establishment of the physician-patient relationship (Norfolk, Birdi, & Walsh, 2007), little
empirical research has been undertaken to identify and measure the factors related to the
development of empathy among medical students.
The present study explored both personal and contextual factors posited to
influence levels of empathy in medical students. Personal factors included self-esteem,
altruism, and personal experience with illness. Medical school year, chosen specialty,
and participation in psycho-social curriculum were considered as contextual factors. It is
hypothesized that controlling for age, gender and race, those medical students with higher
levels of self-esteem and altruism, and those who have had personal experience with
chronic/serious illness, will have higher levels of measured empathy than those medical
students who do not. Additionally, medical students who are in their first year of study,
those who have participated in psycho-social curricular electives, and those who have
selected specialties other than orthopedics or anesthesiology, will have higher levels of
measured empathy than students in later years, students who have not participated in
psycho-social curricular electives, and students who have selected all other medical
specialties.
Four reliable and valid instruments measuring self-esteem, altruism, and
dimensions of empathy constituted the majority of the questions in the online survey.
Descriptive statistics were conducted to describe the sample. Reliability statistics were
run on all scales using Cronbach‟s Alpha, and multiple regression analysis was employed
to test the hypotheses.
Significant findings indicate the following: 1) Medical students with higher
levels of self-esteem and altruism, and those who have had personal experience with
chronic/serious illness, have higher levels of measured empathy; 2) Students participating
in the Mind/Body psycho-social curricular elective have greater levels of empathy than
those not enrolled in this program; 3) Students selecting the specialty category of
Orthopedics/Anesthesiology have lowered measured levels of empathy than students in
other specialties; and, 4) Female students have greater empathy than male students.
This dissertation by Deborah Camalier Walker fulfills the dissertation requirement for the
doctoral degree in Social Work approved by Joseph Shields, PhD, as Director and by
James Zabora, Sc.D., Lynn Mayer, Ph.D., and Aviad Haramati, Ph.D., as Readers.

____________________________
Joseph J. Shields, Ph.D., Director

___________________________
James Zabora, Sc.D., Reader

___________________________
Lynn Mayer, Ph.D., Reader

___________________________
Aviad Haramati, Ph.D., Reader

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DEDICATION
I dedicate this work to my family – Dick, Matthew, Brian, Jessica, Lauren, and
Jee Nah. You have unconditionally supported, encouraged, and loved me throughout the
past six years. I know it wasn‟t always easy, but you helped me to see that it is never too
late.
This is also dedicated to my parents, Charles A. Camalier, Jr. and Anne Davis
Camalier. As a child of the Depression, my father stressed the importance of education,
for he knew it was the only thing that could never be taken away. My mother fostered
the belief that with courage and tenacity, anything is possible.
Lastly, I dedicate this work to the truest friend I have ever known, Blair Richards,
Jr. Despite experiencing medical care that often lacked humanism, his grace in dying led
me to see the necessity and urgency of this research.

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TABLE OF CONTENTS
SIGNATURE PAGE .......................................................................................................... ii
DEDICATION…………………………………………………………………………... iii
TABLE OF CONTENTS…………………………………………………………………iv
LIST OF TABLES……………………………………………………………………….vii
LIST OF FIGURES……………………………………………………………………..viii
ACKNOWLEDGEMENTS……………………………………………………………....ix
CHAPTER 1: INTRODUCTION TO THE STUDY………………………………..........1
Empathy…………………………………………………………………………...3
Factors Influencing Empathy……………………………………………………...4
The Present Study………………………………………………………………... 5
Significance of the Research to Social Work……………………………………..7
Interest in the Problem…………………………………………………………….9
Summary…………………………………………………………………………10

CHAPTER 2: THEORETICAL FOUNDATIONS AND LITERATURE REVIEW......11
Introduction and Overview………………………………………………………11
Theoretical Model and Framework………………………………………………11
Review of the Literature…………………………………………………………16
Empathy………………………………………………………………….16
Personal Factors………………………………………………………….23
Self-Esteem………………………………………………………23
Altruism………………………………………………………….26
Personal Experience with Serious/Chronic Illness………………30
Contextual Factors……………………………………………………….32
Year in Medical School………………………………………….32
Chosen Specialty………………………………………………....34
Participation in Psycho-Social Curriculum……………………....35
Summary………………………………………………………………………....38

CHAPTER 3: METHODOLOGY…………………………………………………........39
Introduction…………………………………………………………………........39
Study Design...…………………………………………………………………...40
Research Questions and Hypotheses…………………………………………….40
Sampling Plan and Data Collection……………………………………………...41
Dependent Variable……………………………………………………………...42
Empathy……..…………………………………………………………...42
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Independent Variables…………………………………………………………47
Personal Factors………………………………………………….…….47
Self-Esteem……………………………………………….……47
Altruism……………………………………………………......49
Personal Experience with Serious/Chronic Illness…………….50
Contextual Factors……………………………………………….….....51
Year in Medical School………………………………….....….51
Medical Specialty………………………………………….…..51
Participation in Psycho-Social Curricular Electives………......53
Data Analysis Plan…………………………………………………….………54
Human Subjects Concerns…………………………………………….…....…54
Summary…………………………………………………………….………...54

CHAPTER 4: FINDINGS………………………………………………………….…55
Introduction…………………………………………………………………....55
Descriptive Findings…………………………………………………………...55
Dimensions of Empathy………………………………………………..............57
Personal Factors………………………………………………………………..58
Contextual Factors……………………………………………….……….....…60
Bivariate Analysis………………………………………………………...…....62
Multivariate Analysis…………………………………………………...…..….74
The Importance of Gender……………………………………...….…..96
The Importance of Self-Esteem…………………………………....…..96
The Importance of Altruism………………………………………....…96
The Importance of the Mind/Body Curricular Offering………….....….97
Significant Findings for Orthopedics/Anesthesiology……………….....97
Summary……………………………………………………………….........….98

CHAPTER 5: SUMMARY AND CONCLUSIONS…………………………………..99
Introduction and Background of the Problem………….....………………...…..99
Purpose of the Study………………………………………………………...…100
Review of the Literature………………………………………………………..101
Theory………………………………………………………………......101
Empathy…………………………………………………………….…..102
Self-Esteem……………………………………………………….…….104
Altruism………………………………………………………….……..105
Personal Experience with Serious/Chronic Illness………………..........106
Year in Medical School………………………………………………...107
Chosen Specialty……………………………………………………….108
Participation in Psycho-Social Curriculum…………………………….109
Methodology………………………………………………………………...…110
Findings…………………………………………………………………….......112
Conclusions………………………………………………………………….....115
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Limitations……………………………………………………............115
Implications…………………………………………………………..115
Georgetown University School of Medicine……………………….. .117

APPENDIX……………………………………………………………………..........119

REFERENCES……………………………………………………………………….127

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LIST OF TABLES
Table 4.1: Characteristics of the Sample………………………………………………..56
Table 4.2: Dimensions of Empathy…...………………………………………………...57
Table 4.3: Personal Factors……..………………………………………...…………..…59
Table 4.4: Contextual Factors………………………………………………………..….61
Table 4.5: Pearson‟s r Correlation Analysis Results………………………………....…63
Table 4.6: Pearson‟s r Correlation Analysis Results for Independent Variables and
Dimensions of Empathy……………………………………………………..69

Table 4.7: Multiple Regression Analysis of Fantasy on Control and Independent
Variables………………………………………………………………….….74
Table 4.8: Multiple Regression Analysis of Perspective Taking on Control and
Independent Variables…………………………………………………….…77

Table 4.9: Multiple Regression Analysis of Empathic Concern on Control and
Independent Variables…………………………………………………….…80

Table 4.10: Multiple Regression Analysis of Personal Distress on Control and
Independent Variables…..……………………………………………….…83

Table 4.11: Multiple Regression Analysis of Repair on Control and Independent
Variables…………………………………………………………………....86

Table 4.12: Multiple Regression Analysis of Attention on Control and Independent
Variables…………………………………………………………………....89

Table 4.13: Multiple Regression Analysis of Clarity on Control and Independent
Variables…………………………………………………………………....92

Table 4.14: Significant Variables Explaining the Dimensions of Empathy……….……95

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LIST OF FIGURES
Figure 1: Model of Factors Influencing Empathy……………………………………..12

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