Background: Empathy is a crucial component of medicine. However, many studies that have used quantitative methods have revealed decline of learners' empathy during undergraduate and postgraduate medical education. We identified medical students' and residents' conceptual structures of empathy in medicine to examine possible differences between the groups in how they conceive empathy. Methods: We conducted a qualitative study with two focus group discussions in which six medical students and seven residents participated separately. The transcripts of the focus group discussions were analysed combining qualitative data analysis and theoretical coding. Results: Medical students and residents had different conceptual structures of empathy. While medical students thought that sharing emotions with patients was essential to showing empathy, residents expressed empathy according to their evaluation of patients' physical and mental health status. If the residents thought that showing empathy was necessary for the care of patients, they could show it, regardless of whether they shared the patients' emotions or not. Conclusions: The comparison of medical students' and residents' conceptual structures of empathy reveals a qualitative difference. Residents show more empathy to their patients by a cognitive decision as clinicians than medical students do. Communication skills training should consider the qualitative change of students' and residents' empathy with clinical experience. We should consider the change when we evaluate learners' empathy and introduce methods that cover the qualitative range of empathy.

Introduction: Graduate healthcare students experience significant stressors during professional training. Mindfulness-Based Stress Reduction (MBSR) is a behavioural intervention designed to teach self-regulatory skills for stress reduction and emotion management. This study examines the impact of MBSR training on students from five healthcare graduate programs in a quasi-experimental trial. Methods : A total of 13 students completed the MBSR program and were compared with 15 controls. Both groups answered validated questionnaires measuring anxiety, burnout and empathy at baseline, at conclusion of the course (week 8) and 3 weeks post-course completion (week 11). Results : Significant decrease in anxiety at weeks 8 and 11 compared with baseline (P<0.001 and P<0.01, respectively) was observed using the Burns Anxiety Inventory. Significant increase in empathy at week 8 (P<0.0096) was observed using the Jefferson Scale of Physician Empathy. Week 11 demonstrated a decrease in empathy from baseline (not statistically significant) across all subjects. No significant differences in burnout scores at weeks 8 and 11 were observed between those in the intervention and control groups. Conclusions : These results provide supportive evidence of MBSR as a behavioural intervention to reduce anxiety and increase empathy among graduate healthcare students.

Objectives: Physiotherapy training in Nigeria is almost 50 years old with no history of appraisal of research projects produced by the physiotherapy students. Physiotherapy students complete research projects in partial fulfilment of the requirements for graduation. An appraisal will reveal areas of strength and weakness in the research requirement for students, potentially leading to better research capacity and promoting evidence-based clinical practice among graduates. This study describes issues related to the study design, scope, statistical analysis and supervision of physiotherapy undergraduates in Nigerian universities. Methods: This retrospective study analysed 864 projects undertaken by Nigerian physiotherapy students between years 2000 and 2010. A maximum of 20 projects per academic year were randomly selected from each of the seven physiotherapy institutions in Nigeria. Data were obtained using a self-designed data retrieval form and analysed using descriptive and inferential statistics. Results: Cross-sectional surveys constituted 47.6% of the research projects with mainly non-probability sampling (57.7%) and lack of objective sample size determination in 91.6% of the projects. Most projects (56.4%) did not report any ethical approval. The particular university attended (χ² = 109.5, P = 0.0001), type of degree offered (χ² = 47.24, P = 0.00001) and the academic qualification of supervisors (χ² = 21.99, P = 0.001) were significantly related to the strength of the research design executed by students. Conclusions: Most research projects carried out by Nigerian physiotherapy students were cross-sectional, characterised by arbitrary sample sizes, and were conducted on human subjects but most without report of ethical approval. Efforts to improve research methodology, documentation and exploration of a wider range of research areas are needed to strengthen this educational experience for students.

Introduction: Case studies are widely used in medical education. They help students recognise and interpret important data coming from the patient's problem thereby enabling students to arrive at a correct diagnosis and best treatment course. We have used the case vignette method, a variant of the case study method, for teaching family medicine residents, and here we assess their perceptions of its advantages and limitations. Methods: In the case vignette method, residents studied a particular case of interest from the community. Before presenting it to peers, they prepared and circulated a brief case vignette outlining the salient features of the case, the preferred line of management and suggested discussion probes. Structured notes were taken by programme faculty during the presentations, and feedback was obtained from residents. Results: Major advantages perceived by residents were that the case vignette method demanded their active participation in the preparation and presentation of the case. The need to prepare a vignette helped them better organise their thinking and experience peer teaching. However, some felt that the exercise was time consuming and the discussion sometimes wandered from the intended course. Conclusions: The case vignette method helps meet specific learning objectives in teaching sessions. Residents feel that it improves their skills as physicians and teachers. This study finds that case vignettes are a promising complement to existing methods of teaching medicine. Further research is required to more firmly establish this method's value.

Background: Patient narratives are a viable process for patients to contribute to the education of future health professionals and social workers. Narratives can facilitate a deeper understanding of the self and others through self-reflection and encourage transformative learning among students. Increasingly, accounts of health and care are available online but their use in health and social work education requires evaluation. This study explored the experiences of stakeholders who contributed to, developed and used an online narrative archive, which was developed in collaboration with five universities and healthcare providers in the North East of England (CETL4HealthNE). Methods: Realistic evaluation principles were used to underpin data collection, which consisted of semi-structured interviews, a focus group and observations of educators using narrative resources in teaching sessions with different professional groups in two universities. Participants included educators, storytellers, narrative interviewers, students and a transcriber. Data were analysed thematically by two researchers and verified by a third researcher. Findings: Stakeholders reported that listening to patient narratives was challenging. The process of contributing the story was a positive cathartic experience for patients, and the powerful storyteller voice often evoked empathy. Students commented on the ability of the online audio-visual narratives to enable them to see the patient holistically, and educators reported that narratives provided a means to introduce sensitive topics. Conclusions: The use of a locally generated online narrative archive is beneficial for storytellers, students and educators, providing an opportunity to influence healthcare professional training. Care needs to be taken when exposing individuals to potentially sensitive narratives.

Introduction: Health professions education uses innovative projects to promote faculty development and institution change. Faculty perceptions of the factors that promote project sustainability affect how faculty conceptualize and implement their innovations, which influences whether and how they plan for sustainability. This paper compares educators' perceptions of factors that influence sustainability in innovative projects with factors identified in project sustainability literature, to identify areas of convergence and divergence. Methods: Using questionnaires, faculty development fellowship participants from Brazil and India shared their perceptions on factors influencing their project's sustainability. An analysis framework was developed from existing project sustainability literature; faculty responses were then coded through an iterative process. Results: Key sustainability themes identified by faculty included project-level factors related to project design, stakeholder support, monitoring and evaluation, and project outcomes. Identified context level factors were related to institutional and governmental support as well as self-motivation and peer support. Availability of resources and funding were identified as relevant at both the project and context levels. Project-level factors were more often cited than context-level factors as key to ensuring sustainability. Conclusions: Faculty development efforts in health professions education should employ strategies to target these themes in promoting innovation sustainability. These include preengagement with institutional leaders, alignment with public sector goals, strategic diffusion of information, project expansion and transferability, capacity building in monitoring and evaluation, and creation of a community of educators for information exchange and support.

Context: There is considerable evidence that emotional intelligence, previous academic achievement (i.e. cumulative grade point average (GPA)) and personality are associated with success in various occupational settings. This study evaluated the relationships of these variables with psychological health of first year medical students during stressful periods. Methods: A 1-year prospective study was done with students accepted into the School of Medical Sciences, Universiti Sains Malaysia. Information on emotional intelligence, GPA and personality traits were obtained prior to admission. The validated Universiti Sains Malaysia Emotional Quotient Inventory and Universiti Sains Malaysia Personality Inventory were used to measure emotional intelligence and personality traits, respectively. Stress, anxiety and depression were measured by the 21-item Depression Anxiety Stress Scale during the end-of-course (time 1) and final (time 2) examinations. Results: At the less stressful period (time 1), stress level was associated with agreeableness and the final GPA, anxiety level was associated with emotional control and emotional conscientiousness and depression level was associated with the final GPA and extraversion. At the more stressful period (time 2), neuroticism associated with stress level, anxiety level was associated with neuroticism and emotional expression, and depression level was associated with neuroticism. Conclusions: This study found that neuroticism was the strongest associated factor of psychological health of medical students during their most stressful testing period. Various personality traits, emotional intelligence and previous academic performance were associated factors of psychological health during a less stressful period. These data suggest that early identification of medical students who are vulnerable to the stressful environment of medical schools might help them maintain psychological well-being during medical training.

Background: The Internet is increasingly used as a source of health-related information. The objective of this study was to assess the quality of web-based information on treatments for attention-deficit/hyperactivity disorder (ADHD). Methods: Sixteen expert health professionals in ADHD and 35 parents of paediatric patients with a recent diagnosis of ADHD assessed the information contained in the 10 highest ranked websites in Spanish, using the Spanish version of the DISCERN tool - a validated questionnaire designed to assess the quality and reliability of web-based information on treatment choices (rating scores from 15 to 75). Results: DISCERN scores given by parents and experts were low (total mean scores [standard deviation]: 35.9 [13.1] and 43.4 [13.7], respectively) and inter-rater agreement was poor/moderate (weighted kappa for the global assessment between -0.69 and +0.93, average = 0.29). There was a significant change on the ADHD-knowledge and motivation for treatment (ADHD-KMT) basic knowledge sub-scale score after the assessment of the different websites by parents (total mean scores [standard deviation]: 49.09 [9.46] and 63.21 [9.45]). Conclusions: Despite a poor/moderate inter-rater agreement between parent and expert opinions, all agreed that the quality of the web-based information on treatment choices for ADHD is generally poor.

Context: Although inter-professional collaboration is important for patient safety, effective collaboration can be difficult to achieve, especially in settings with a strong hierarchical or blame culture. Educational Model: Leary's Rose is a model that gives insight into the hierarchical positions people take during a negotiation process. The assumption behind this tool is that the default reaction we intuitively choose is not always the most effective. Becoming aware of this default reaction makes it possible to choose to behave differently, in a more effective way. We propose to use this model to make health professionals more aware of their attitudes and communication styles when negotiating and provide them with a tool to improve communication by modifying their natural responses. Application: Leary's Rose can be used in simulated and authentic work-based educational settings. To train the communication skills of nurses to be the patients' advocates, for example Leary's Rose was used in role plays in which nurses have to negotiate in the patients' interest with the doctor while they have to maintain partnership relationship and avoid opposition with the doctor.

Introduction: The current emphasis on providing holistic competent and efficient healthcare has revealed a need to nurture providers' compassionate and relationship-centred care throughout the continuum of medical education. Methods: Our resident-as-teacher programme trained 41 residents from core clerkships at six clinical sites in the United States of America (USA) to teach and practice compassionate care through role-modelling. The programme focused on resident's demonstrations or failures to demonstrate compassionate care with peers, students and healthcare providers, and engaged residents in disseminating their experience to their colleagues. A mixed-method evaluation assessed short-term outcomes at multiple levels through the collection of resident's: pre- and post-programme scores on empathy scale, performance on standardised patient (SP) exercise, and self-assessment of their performance on relationship-centred care skills; journal reflections; presentations delivered at their site and attendees' evaluation; evaluation of the programme. Quantitative data was analysed calculating descriptive statistics and paired sample t-tests, using SAS. Qualitative data was analysed performing open coding and code frequency counts to identify emergent themes. Results: Residents had empathy scores within the average range, and high scores on SP assessments throughout the programme. The programme had a positive impact on resident's perceptions of their relationship-centred skills. Residents found the programme useful, and emphasised the importance of mindfulness, active presence and slowing down-and were concerned with addressing these needs in daily practice. Eighteen presentations were delivered across sites. Attendees found the presentations useful and necessary in their training. Conclusions: Residents successfully reflected on, embodied and disseminated the programme's core concepts on their rotations. This group required validation of their commitment to compassionate care, and sought strategies to embody their commitment while inspiring other providers, residents and students.