Rizkalla MN, Henderson KK. Empathy and Osteopathic Manipulative Medicine: Is It All in the Hands?. J Am Osteopath Assoc 2018;118(9):573–585. doi: 10.7556/jaoa.2018.131.
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The osteopathic medical school curriculum is unique because of the inclusion of training in osteopathic manipulative medicine (OMM). Interest in and use of OMM promotes cognitive training in diagnosing conditions, emotional training in the alleviation of pain, and physical training in the application of OMM. Osteopathic manipulative medicine may mitigate a reduction in empathy levels of medical students and explain why osteopathic medical students do not follow the declining pattern of empathy previously reported in allopathic medical students.
To examine whether favorable opinions of OMM are positively correlated with overall student empathy as well as the cognitive, emotional, and behavioral subcomponents of empathy.
Institutional review board approval was obtained to measure empathy in medical students attending the Midwestern University/Chicago College of Osteopathic Medicine for this cross-sectional study. The 20-item Jefferson Scale of Empathy medical student version (JSE-S) was distributed via email to first-year students at the beginning of the 2016-2017 academic year and at the end of the academic year to all students. Items were divided into cognitive, emotional, and behavioral categories. Items related to demographics, interest and use of OMM and the osteopathic philosophy, frequency of touch, and personality were also included in the survey. Data were analyzed using SPSS software and presented as mean (SEM). Statistical significance was set at P<.05.
Of the 801 students the survey was sent to at the end of the 2016-2017 academic year, 598 students completed the survey, for a response rate of 75%. When accounting for the effect of gender with a multivariate analysis of covariance, there were no differences in empathy scores across school years. When empathy scores from first- and second-year students were combined and compared with combined third- and fourth-year students’ scores to examine the difference between empathy in students during academic and clinical training, a difference in the mean (SEM) JSE-S empathy score was noted (114.6 [0.7] and 112.0 [0.7], respectively; P=.01); however, the effect size was small (partial η2=0.01). Interest in OMM and the osteopathic philosophy were significantly associated with higher empathy scores (P<.05; medium effect; partial η2=0.08).
Interest in and use of OMM are associated with higher empathy scores and empathy subcomponents. Training and use of OMM should be examined as a mechanism contributing to the durability of empathy in the osteopathic medical profession.
a Two surveys were sent in the 2016-2017 academic year: the first in August 2016 to first-year osteopathic medical students (OMS I) and the second in April, May, or June 2017, depending on the class, to all osteopathic medical students (OMS I-IV).
b The Jefferson Scale of Empathy medical student version (JSE-S) consists of 20 items rated on a scale of 1-7, for a total potential score range of 20-140. Higher scores indicate greater empathy. Scores on the JSE-S were significantly higher among female than male participants in each class year (P<.05). No significant differences were found in JSE-S scores between classes. In the grouped classes, compared with clinical classes (OMS III-IV), academic classes (OMS I-II) had a significantly higher JSE-S score and cognitive and emotional subcomponents (P≤.02), but effect sizes were small (partial η2=0.01).
c The 20 items in the JSE-S were divided based on cognitive, emotional, or behavioral content. The total potential score of the 9 cognitive items was 9-63; 7 emotional items, 7-49; and 4 behavioral items, 4-28. Scores were converted to percentages of the highest total score for each range.
a The Jefferson Scale of Empathy medical student version (JSE-S) consists of 20 items rated on a scale of 1-7, for a total potential score range of 20-140.
b The 20 items in the JSE-S were divided based on cognitive, emotional, or behavioral content. The total potential score of the 9 cognitive items was 9-63; 7 emotional items, 7-49; and 4 behavioral items, 4-28. Scores were converted to percentages of the highest total score for each range.
d Medium effect size (r2≥0.05).
Abbreviations: OMM, osteopathic manipulative medicine; OMT, osteopathic manipulative treatment.
c Mann-Whitney tests with significant differences in empathy (P<.05) but small effect size (r2<0.01).
Abbreviation: OMT, osteopathic manipulative treatment.
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