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University of Dundee DOCTOR OF University of Dundee DOCTOR OF MEDICINE A Study of the Consultation and Relational Empathy (CARE) Measure for Medical Students Alnoman, Nashwan Nemat Hanna Award date: 2014 Link to publication General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. Download date: 27. Sep. 2021 DOCTOR OF MEDICINE A Study of the Consultation and Relational Empathy (CARE) Measure for Medical Students Nashwan Nemat Hanna Alnoman 2014 University of Dundee Conditions for Use and Duplication Copyright of this work belongs to the author unless otherwise identified in the body of the thesis. It is permitted to use and duplicate this work only for personal and non-commercial research, study or criticism/review. You must obtain prior written consent from the author for any other use. Any quotation from this thesis must be acknowledged using the normal academic conventions. It is not permitted to supply the whole or part of this thesis to any other person or to post the same on any website or other online location without the prior written consent of the author. Contact the Discovery team ([email protected]) with any queries about the use or acknowledgement of this work. i A Study of the Consultation and Relational Empathy (CARE) Measure for Medical Students Nashwan Nemat Hanna Alnoman Thesis Submitted for the Degree of PhD UNIVERSITY OF DUNDEE May 2014 i Dedication To my dearest wife and lovely children To my dad soul, my mother, brother and sister To all who support & encourage ii List of Content Content Page NO. Dedication i List of Contents ii List of Figures ix List of Tables x List of Appendices xii Acknowledgements xiii Declaration xiv Summary of Thesis xv List of Abbreviations xviii 1 Introduction ........................................................................................... 1 1.1 The importance of healthcare quality .......................................................... 1 1.1.1 ‘Better Health, Better Care’ ...................................................................... 1 1.1.2 ‘The Healthcare Quality Strategy for NHSScotland’................................ 2 1.1.3 The person-centred approach ................................................................... 3 1.2 Rational of the study ...................................................................................... 6 1.3 Aim of thesis .................................................................................................... 7 1.4 Overview of the thesis .................................................................................... 7 2 Literature review ................................................................................. 10 2.1 Scope of the literature review ...................................................................... 10 2.2 Sources used in this study ............................................................................ 10 2.3 Development of the clinical consultation .................................................... 13 2.4 The clinical consultation .............................................................................. 14 2.4.1 Common models of the consultation ....................................................... 14 iii 2.4.2 Consultation skills and the doctor–patient relationship ......................... 18 2.4.3 The development of the doctor–patient relationship ............................... 18 2.4.4 The effect of the doctor–-patient relationship ......................................... 20 2.4.5 The doctor–patient relationship in medical education ........................... 22 2.5 Empathy in the healthcare context ............................................................. 26 2.5.1 Definition and historical background ..................................................... 26 2.5.2 Empathy and quality of healthcare ......................................................... 29 2.5.3 The effect of empathy on patient enablement and health outcome ......... 31 2.5.4 Empathy in medical education ................................................................ 34 2.5.5 Empathy decline ...................................................................................... 35 2.5.6 The need for empathy measure ............................................................... 38 2.6 Assessment in medical education ................................................................ 41 2.6.1 General principles of assessment ............................................................ 41 2.6.2 Criteria for good assessment processes .................................................. 43 2.6.3 Assessment in undergraduate medical education ................................... 44 2.6.3.1 Miller’s model of assessment .................................................................................. 44 2.6.3.2 The Cambridge Model ............................................................................................ 46 2.6.4 Formative and summative assessments ................................................... 47 2.6.4.1 Combining formative and summative assessments............................................... 49 2.6.5 The importance of feedback on consultation skills ................................. 51 2.6.6 Methods of feedback in medical education ............................................. 52 2.6.7 Assessment as programme ...................................................................... 55 2.6.8 Competency and outcome-based assessment .......................................... 56 2.6.8.1 Blueprinting ............................................................................................................. 58 2.7 Key concepts in assessment ......................................................................... 59 2.7.1 Utility of assessment ................................................................................ 59 2.7.2 The validity of the assessment tools ........................................................ 60 2.7.3 The reliability of assessment tools .......................................................... 63 iv 2.7.4 Types of reliability .................................................................................. 65 2.7.5 Reducing measurement error and improving reliability ......................... 69 2.7.6 The relationship between reliability and validity of assessment tools .... 71 3 Systematic review of empathy measures for health professionals . 73 3.1 Introduction .................................................................................................. 73 3.2 Background and rationale ........................................................................... 73 3.3 The aim of the systematic review in this thesis .......................................... 75 3.4 Search strategy ............................................................................................. 76 3.4.1 Selection criteria ..................................................................................... 76 3.4.2 Search procedure .................................................................................... 77 3.4.3 Data extraction........................................................................................ 80 3.4.4 Synthesis .................................................................................................. 84 3.4.5 Limitations .............................................................................................. 84 3.5 Measures of empathy for health professionals .......................................... 86 3.5.1 Self-report empathy measures ................................................................. 86 3.5.1.1 Jefferson Scale of Physician Empathy ................................................................... 86 3.5.1.2 Hogan’s Empathy Scale .......................................................................................... 88 3.5.1.3 The Interpersonal Reactivity Index ....................................................................... 90 3.5.1.4 The Empathy Communication Skills Scale ........................................................... 92 3.5.1.5 The Balanced Emotional Empathy Scale ............................................................... 93 3.5.2 Patient-rating empathy measures ........................................................... 94 3.5.2.1 The Consultation and Relational Empathy Measure ........................................... 94 3.5.3 Observer-rating empathy measures ........................................................ 96 3.5.3.1 The Four Habits Coding Scheme ........................................................................... 96 3.5.3.2 Empathic Communication Coding System ............................................................ 98 3.5.4 Combined empathy measures .................................................................. 99 3.5.4.1 The
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