***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Physician empathy is an essential attribute of the patient – physician relationship and is associated with better outcomes , greater patient safety and fewer mal practice cl aims . Objective We tested whether an innovative empathy training protocol grounded in neuroscience could improve  physician empathy  as rated by patients . Design R and omized controlled trial . InterventionWe r and omly assigned residents and fellows from surgery , medicine , anesthesiology , psychiatry , ophthalmology , and orthopedics ( N = 99 , 52 % female , mean age 30.6 ± 3.6 ) to receive st and ard post-graduate medical education or education augmented with three 60-minute empathy training modules . Main MeasurePatient ratings of physician empathy were assessed within one-month pre-training and between 1–2 months post-training with the use of the Consultation and Relational Empathy ( CARE ) measure . Each physician was rated by multiple patients ( pre-mean = 4.6 ± 3.1 ; post-mean 4.9 ± 2.5 ) , who were blinded to physician r and omization . The primary outcome was change score on the patient-rated CARE.Key Results The empathy training group showed greater changes in patient-rated CARE scores than the control ( difference 2.2 ; P = 0.04 ) . Trained physicians also showed greater changes in knowledge of the neurobiology of empathy ( difference 1.8 ; P < 0.001 ) and in ability to decode facial expressions of emotion ( difference 1.9 ; P < 0.001 ) . Conclusions A brief intervention grounded in the neurobiology of empathy significantly improved physician empathy as rated by patients , suggesting that the quality of care in medicine could be improved by integrating the neuroscience of empathy into medical education Background and Purpose Communication with patients is a core clinical skill in medicine that can be acquired through communication skills training . Meanwhile , the importance of transfer of communication skills to the workplace has not been sufficiently studied . This study aims to assess the efficacy of a 40-hour training program design ed to improve patients ' satisfaction and residents ' communication skills during their daily clinical rounds . Methods Residents were r and omly assigned to the training program or to a waiting list .  Patients ' satisfaction was assessed with a visual analog scale after each visit . Transfer of residents ' communication skills was assessed in audiotaped actual inpatient visits during a half-day clinical round . Transcripted audiotapes were analyzed using content analysis software ( LaComm ) . Training effects were tested with Mann-Whitney tests and generalized linear Poisson regression models . Results Eighty-eight residents were included . First , patients interacting with trained residents reported a higher satisfaction with residents ' communication ( Median = 92 ) compared to patients interacting with untrained residents ( Median = 88 ) ( p = .046 ) . Second , trained residents used more assessment utterances ( Relative Risk ( RR ) = 1.17 ; 95 % Confidence intervals ( 95%CI ) = 1.02–1.34 ; p = .023 ) . Third , transfer was also observed when residents ' training attendance was considered : residents ' use of assessment utterances ( RR = 1.01 ; 95%CI = 1.01–1.02 ; p = .018 ) and supportive utterances ( RR = 0.99 ; 95%CI = 0.98–1.00 ; p = .042 ) ( respectively 1.15 ( RR ) , 1.08–1.23 ( 95%CI ) , p<.001 for empathy and 0.95 ( RR ) , 0.92–0.99 ( 95%CI ) , p = .012 for reassurance ) was proportional to the number of hours of training attendance . Conclusion The training program improved patients ' satisfaction and allowed the transfer of residents ' communication skills learning to the workplace . Transfer was directly related to training attendance but remained limited . Future studies should therefore focus on the improvement of the efficacy of communication skills training in order to ensure a more important training effect size on transfer OBJECTIVE This study 's objective was to assess the relationship of empathy in medical office visits to subsequent outcomes of the common cold . METHODS A total of 350 subjects ? 12 years of age received either a st and ard or enhanced physician visit as part of a r and omized controlled trial . Enhanced visits emphasized empathy on the part of the physician . The patient-scored Consultation and Relational Empathy ( CARE ) question naire assessed practitioner-patient interaction , especially empathy . Cold severity and duration were assessed from twice-daily symptom reports . Nasal wash was performed to measure the immune cytokine interleukin-8 ( IL-8 ) . RESULTS Eighty-four individuals reported perfect ( score of 50 ) CARE scores . They tended to be older with less education but reported similar health status , quality of life , and levels of optimism . In those with perfect CARE scores , cold duration was shorter ( mean 7.10 days versus 8.01 days ) , and there was a trend toward reduced severity ( mean area under receiver-operator characteristics curve 240.40 versus 284.49 ) . After accounting for possible confounding variables , cold severity and duration were significantly lower in those reporting perfect CARE scores . In these models , a perfect score also correlated with a larger increase in IL-8 levels . CONCLUSIONS Clinician empathy , as perceived by patients with the common cold , significantly predicts subsequent duration and severity of illness and is associated with immune system changes OBJECTIVE To examine the causal effects of doctor-patient relations and the severity of a medical outcome on medical patient perceptions and mal practice intentions in the event of an adverse medical outcome . DESIGN R and omized between-subjects experimental design . Patients were given scenarios depicting interactions between an obstetric patient and her physician throughout the patient 's pregnancy , labor , and delivery . PARTICIPANTS One hundred twenty-eight postpartum obstetric patients were approached for participation , of whom 104 completed the study . Main outcome measures Patients ' perceptions of physician competence and intentions to file a mal practice cl aim . RESULTS Positive physician communication behaviors increased patients ' perceptions of physician competence and decreased mal practice cl aim intentions toward both the physician and the hospital . A more severe outcome increased only patients ' intentions to sue the hospital . CONCLUSION These results provide empiric evidence for a direct , causal effect of the doctor-patient relationship on medical patients ' treatment perceptions and mal practice cl aim intentions in the event of an adverse medical outcome PURPOSE . To use a controlled , r and omized design to assess the effect on patient satisfaction of an  intensive psychosocial training program for residents . METHOD . Twenty-six first-year residents , in two internal medicine and family practice community-based programs affiliated with the Michigan State University College of Human Medicine , were r and omly assigned during 1991 and 1992 to a control group or a one-month intensive training program . Experiential teaching focused on many psychosocial skills required in primary care . A 29-item question naire administered before and after the residents ' training evaluated their patients ' satisfaction regarding patient disclosure , physician empathy , confidence in physician , general satisfaction , and comparison of the physician with other physicians . Analyses of covariance with groups and gender as factors and pre-training patient satisfaction scores as the covariate evaluated the effect of the training . RESULTS . The patients of the trained residents expressed more confidence in their physicians ( p = .01 ) and more general satisfaction ( p = .02 ) than did the patients of controls . The effect of training on patient satisfaction with patient disclosure ( p < .01 ) and physician empathy ( p < .05 ) was greater for female than for male residents . CONCLUSION . The intensive psychosocial training program for residents improved their patients ' satisfaction The inability to cope successfully with the enormous stress of medical education may lead to a cascade of consequences at both a personal and professional level . The present study examined the short-term effects of an 8-week meditation-based stress reduction intervention on premedical and medical students using a well-controlled statistical design . Findings indicate that participation in the intervention can effectively ( 1 ) reduce self-reported state and trait anxiety , ( 2 ) reduce reports of overall psychological distress including depression , ( 3 ) increase scores on overall empathy levels , and ( 4 ) increase scores on a measure of spiritual experiences assessed at termination of intervention . These results ( 5 ) replicated in the wait-list control group , ( 6 ) held across different experiments , and ( 7 ) were observed during the exam period . Future research should address potential long-term effects of mindfulness training for medical and premedical students OBJECTIVE To evaluate the effects of patient-practitioner interaction on the severity and duration of the common cold . METHODS We conducted a r and omized controlled trial of 719 patients with new cold onset . Participants were r and omized to three groups : no patient-practitioner interaction , " st and ard " interaction or an " enhanced " interaction .  Cold severity was assessed twice daily . Patients r and omized to practitioner visits used the Consultation and Relational Empathy ( CARE ) measure to rate clinician empathy . Interleukin-8 ( IL-8 ) and neutrophil counts were obtained from nasal wash at baseline and 48 h later . RESULTS Patients ' perceptions of the clinical encounter were associated with reduced cold severity and duration . Encounters rated perfect on the CARE score had reduced severity ( perfect : 223 , sub-perfect : 271 , p=0.04 ) and duration ( perfect : 5.89 days , sub-perfect : 7.00 days , p=0.003 ) . CARE scores were also associated with a more significant change in IL-8 ( perfect : mean IL-8 change 1586 , sub-perfect : 72 , p=0.02 ) and neutrophil count ( perfect : 49 , sub-perfect : 12 , p=0.09 ) . CONCLUSIONS When patients perceive clinicians as empathetic , rating them perfect on the CARE tool , the severity , duration and objective measures ( IL-8 and neutrophils ) of the common cold significantly change . PRACTICE IMPLICATION S This study helps us to underst and the importance of the perception of empathy in a therapeutic encounter CONTEXT Primary care physicians report high levels of distress , which is linked to burnout , attrition , and poorer quality of care . Programs to reduce burnout before it results in impairment are rare ; data on these programs are scarce . OBJECTIVE To determine whether an intensive educational program in mindfulness , communication , and self-awareness is associated with improvement in primary care physicians ' well-being , psychological distress , burnout , and capacity for relating to patients . DESIGN , SETTING , AND PARTICIPANTS Before- and -after study of 70 primary care physicians in Rochester , New York , in a continuing medical education ( CME ) course in 2007 - 2008 . The course included mindfulness meditation , self-awareness exercises , narratives about meaningful clinical experiences , appreciative interviews , didactic material , and discussion . An 8-week intensive phase ( 2.5 h/wk , 7-hour retreat ) was followed by a 10-month maintenance phase ( 2.5 h/mo ) . MAIN OUTCOME MEASURES Mindfulness ( 2 subscales ) , burnout ( 3 subscales ) , empathy ( 3 subscales ) , psychosocial orientation , personality ( 5 factors ) , and mood ( 6 subscales ) measured at baseline and at 2 , 12 , and 15 months . RESULTS Over the course of the program and follow-up , participants demonstrated improvements in mindfulness ( raw score , 45.2 to 54.1 ; raw score change [ Delta ] , 8.9 ; 95 % confidence interval [ CI ] , 7.0 to 10.8 ) ; burnout ( emotional exhaustion , 26.8 to 20.0 ; Delta = -6.8 ; 95 % CI , -4.8 to -8.8 ; depersonalization , 8.4 to 5.9 ; Delta = -2.5 ; 95 % CI , -1.4 to -3.6 ; and personal accomplishment , 40.2 to 42.6 ; Delta = 2.4 ; 95 % CI , 1.2 to 3.6 ) ; empathy ( 116.6 to 121.2 ; Delta = 4.6 ; 95 % CI , 2.2 to 7.0 ) ; physician belief scale ( 76.7 to 72.6 ; Delta = -4.1 ; 95 % CI , -1.8 to -6.4 ) ; total mood disturbance ( 33.2 to 16.1 ; Delta = -17.1 ; 95 % CI , -11 to -23.2 ) , and personality ( conscientiousness , 6.5 to 6.8 ; Delta = 0.3 ; 95 % CI , 0.1 to 5 and emotional stability , 6.1 to 6.6 ; Delta = 0.5 ; 95 % CI , 0.3 to 0.7 ) . Improvements in mindfulness were correlated with improvements in total mood disturbance ( r = -0.39 , P < .001 ) , perspective taking subscale of physician empathy ( r = 0.31 , P < .001 ) , burnout ( emotional exhaustion and personal accomplishment subscales , r = -0.32 and 0.33 , respectively ; P < .001 ) , and personality factors ( conscientiousness and emotional stability , r = 0.29 and 0.25 , respectively ; P < .001 ) . CONCLUSIONS Participation in a mindful communication program was associated with short-term and sustained improvements in well-being and attitudes associated with patient-centered care . Because before- and -after design s limit 
    Output:
    
Conclusions  Physician empathy appears to be an important aspect of patient and physician well-being .
Although the current empathy intervention literature is limited by a variety of method ological weaknesses , a sample of high- quality study design s provides initial support for the notion that  physician empathy  can be enhanced through interventions .