Qom University of Medical Sciences Journal

Empathy with patient can improve the ability of physicians to create a proper treatment environment and understand the patients’ responses to health issues. It can facilitate and increase the probability of identifying patients’ needs by reducing stress, anxiety and depression in patients. Considering that in the curriculum of medical students in Qom University of Medical Sciences (QUMS), there is no any course related to the early patient contact, and there is no systematic study about this program, and given that empathy with patients is one of the strengths of patient care, this study aims to design and implement an early patient contact program to investigate its effect on the empathy of medical students of QUMS.
Methods
This is a case-control interventional study. A total of 64 students from QUMS in the sixth and seventh semesters of physiopathology were included in the study using a convenience sampling method. The inclusion criteria were: passing at least 4 semesters, not participating in clinical rounds, and no psychiatric disorders in the first- and second-degree relatives. The exclusion criteria were: unwillingness to continue participation in the study for any reason, and attending the coronavirus-related, intensive care, and infectious wards. Participants were randomly divided into intervention and control groups. The instrument used in this study was the Jefferson Scale of Empathy (JSE) with 20 items which assess the communication skills, quality of human relations, and medical expertise. This scale has a content validity higher than 0.79.
First, both the groups completed the JSE Questionnaire, Then, both groups received training based on four one-hour webinar sessions as well as educational materials in a social media application (with topics such as familiarization with medical record files, skills of communication with patients, the correct method of taking medial history from patients, ethical issues in dealing with patients, and empathy with patients), and in the form of PowerPoint files, educational clips, exercises with delayed answers, questions & answers for one month. All the materials sent in the social media group were related to early contact with patients. In the next stage, for the intervention group, three sessions of attending in the hospital were held by the formation of small groups. In these sessions, the students interacted with the patients using the skills learned during one month. Finally, the level of empathy with patients was measured using the JSE again. The collected data were entered into SPSS software, verion 22 and analyzed using chi-square test and paired t-test. The significance level was set at 0.05.
Results
The mean±SD age of participants was 23.6±1.4 years in the intervention group and 22.9±1.5 years in the control group. Of 64 participants, 32 were male and 32 were female; 32 were from other cities living in dormitories and 32 were the local residents; 30 (93.8%) in the intervention group and 29 (90.6%) in the control group were Iranian and the rest were non-Iranian; 54 (84.4%) were single and 10 (15.6%) were married. There was no significant difference between the two groups in terms of age (P=0.06), gender (P=0.13), place of residence (P=0.31), nationality (P=0.64), and marital status (P=0.49). The variables of gender (P=0.38), nationality (P=0.6), place of residence (P=0.9), marital status (P=0.73), age (P=0.25) had no significant relationship with the score of empathy. The pretest empathy score in the intervention group was 64.9±8.5, which increased to 74.4±10.3 after the intervention. In the control group, the pretest empathy score was 73.8±21.6, which decreased to 68.3±8.1 after the intervention. A statistically significant difference was found between the pretest and posttest empathy scores in the control group (P<0.05). Before the intervention, the empathy score was not significantly different between the two groups. After the intervention, the difference was statistically significant.
Discussion
Early patient contact before the start of the internship period increases the empathy of medical students. There is a need for the provision of conditions for medical students to communicate with patients before working in the hospital. The accurate assessment of medical students’ perceptions in this regard can lead to the identification of key problems in clinical education. Appropriate strategies can be used to increase the effectiveness of teaching communication skills and empathy in medical students.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Shahid Beheshti University of Medical Sciences (Code: IR.SBMU.SME.REC.1400.055).

Funding
This study was funded by Shahid Beheshti University of Medical Sciences.
Authors contributions
All authors contributed equally in preparing all parts of the research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to thank the Deputy for Research and Technology of Shahid Beheshti University of Medical Sciences and all students participated in the study for their support and cooperation.