How Should We Teach Empathy to PA Students?

We, as educators, ask that our students “connect” with their patients — but how do we effectively teach them to do this? Empathy is the experience of understanding another person’s condition from their perspective — placing yourself in their shoes. It should not be thought of as simply extending a hand from a position of authority as an exercise of charity, but rather walking beside them and sharing in their struggle.

Should empathy be taught as a component of professionalism or a behavioral skill or attitude? I believe that it must entail a combination, but that first you must take the altruistic pulse of your current PA class. Some students may already possess an innate intuition when it comes to the art of empathy, while others may fear or avoid its “touchy-feely-ness.”

So, where does empathy belong in the PA curricula, and how can we best teach it?

Empathy should be modeled on a daily basis by the PA faculty.

After all, don’t we know first-hand the emotional demands of being a PA student? PA students are constantly looking to their professors for guidance. PA faculty have the opportunity to role-model a supportive approach by making direct eye contact, spending more time with students where feasible, having an “open-door policy” or flexible office hours, taking on more of an advisor role, or being a role model in the clinic as a preceptor.

Charismatic and energetic speakers demand presence, and if PA faculty can prove their passion for the students in the classroom (just as one would for their patients), then inspiration will be sparked to follow suit. The same is true of modeling empathy.

The subject of empathy can be integrated into any course, but more specifically would be valuable in an ethics, behavioral medicine, or community-based or cross-cultural medicine course.

As clinicians, we incorporate a “patient-centered” approach. Thus, as educators, we must embody a “student-centered” approach — keeping the student at the center of everything we do. (Unfortunately, this is easily lost when we have so much on our plates.)

Show diversity in the classroom, for example, through the selection of students and faculty.

Appreciate students and faculty from diverse backgrounds, just as you appreciate patients from different backgrounds. We acknowledge that not all patients are the same, and the same is true of our students. It’s important to meet them where they are.

Think of the teaching of empathy as an ethical responsibility.

Empathy is the foundation on which we are able to preserve a valuable relationship with our patients. Future PAs will be making real moral decisions — so it’s critical that we promote empathic communication as a PA competency. Educators should encourage students to first understand their own unconscious bias regarding reactions to illness and then evaluate their own coping mechanisms.

A responsible PA transforms empathy into action by improving their situation and education, connecting with family support, and integrating social services.

Instruction on empathy must be face-to-face, not online or via simulation.

By proposing “real life” scenarios within their presence, a teacher can provide immediate feedback and further gauge the student’s observable responses. It’s also important to ensure adequate class time for discussion and to think through how you might combine lecture and class time with clinical experience.

Incorporate a team-based learning or small-group exercise of a patient encounter to discover what is considered important to the patient.

By working through a team-based learning case, assigning application questions and/or a post-lecture reflective essay, faculty can continue to coax students out of their comfort zone, thus making them more open to understanding the discomfort of their patients. Examples of this might include completing a listening/reflection exercise, practicing “prescribing” empathy just as you would a treatment plan, working through a case study discussion, taking OSCEs, or participating in role-play scenarios regarding patients who are homeless and/or who have a disability. By teaching PA students to treat the whole person, we take on a humanistic approach rather than just a scientific one.

Teaching empathy must involve active learning, critical thinking, and self-reflection. 

Students tend to have a knee-jerk reaction to critical thinking exercises as “busy work.” Nevertheless, it’s a good practice to challenge students to reflect on how they can put their own values to practice for the patient’s benefit. For example, teachers could incorporate an online discussion board, implement the use of narratives or reflection pieces into assessments, or incorporate an open-ended assignment after students visit with a patient. After such tasks, further discussion between students and faculty can allow each to share their feelings and support one another.

Empathy breeds patient trust — as well as patient satisfaction — and reduces the chances of inadvertently judging others. Teaching empathy includes exposure to life-changing interactions that go beyond the classroom. When we think of patient encounters as simply two people sharing an experience, this helps us to realize not only our potential as health care providers, but also our potential as human beings.