***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: 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 describe the process for developing interrater reliability ( IRR ) for the Four Habits Coding Scheme ( 4HCS ) for a heterogeneous material as part of a r and omized controlled trial . METHODS Videotapes from 497 hospital encounters involving 71 doctors from most clinical specialties were collected . Four experienced psychology students were trained as raters . We calculated Pearson 's r and the intraclass correlation ( ICC ) on the total score across consecutive sample s of twenty videos , and Pearson 's r on single videos across items in the initial coding phase . RESULTS After 18h of training and one rating session , the total score Pearson 's r and ICC exceeded .70 for all pairs of raters . Across items within single videos , the Pearson 's r was never below 0.60 after the first 50 videos . At item and habit level Pearson 's r remained unsatisfactory for some rater pairs mostly due to low variance on some items . CONCLUSION Based on the evaluation of the effect of communication skills training via a total score , IRR was satisfactory for the 4HCS as applied to heterogeneous material . However , good reliability at item level was difficult to achieve . PRACTICE IMPLICATION S 4HCS may be used as an outcome measure for clinical communication skills in r and omized controlled trials 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 The exp and ing number of Americans living with chronic illness necessitates educating future physicians about chronic illness care . Weill Cornell Medical College 's Chronic Illness Care in the Home Setting Program ( CIC-HSP ) , a m and atory part of the primary care clerkship , exposes medical students to persons with chronic illness via a half day of house calls with a geriatrics team . The investigators sought to qualitatively assess the effect of the CIC-HSP on medical students and recent medical graduates . Fifty-two prospect i ve participants were approached , and 50 ( 96 % ) with varying training levels and time since completing the program were interviewed . Most respondents ( 63 % ) found that the home visits taught them important approaches to caring for the chronically ill , such as individualizing care to meet patients ' individual needs and improving quality of life as a goal of care . Students remarked that the experience enhanced their empathy ( 18 % ) and sensitivity ( 20 % ) toward chronically ill patients and increased their appreciation for chronic illness care ( 35 % ) . Many participants reported that patients were more empowered in the home ( 55 % ) and perceived greater rapport and warmth between the doctor and patient ( 57 % ) in the home ( vs office ) setting . The vast majority of recent medical graduates ( 84 % ) related that this educational exposure continued to positively influence their approach to patient care . A home visit experience with a geriatrics team can help foster medical students ' underst and ing of the psychosocial and medical aspects of chronic illness , teach relevant approaches to patient care , and improve students ' attitudes toward caring for the chronically ill CONTEXT It has been reported that medical students become more cynical as they progress through medical school . This can lead to a decline in empathy . Empirical research to address this issue is scarce because the definition of empathy lacks clarity , and a tool to measure empathy specifically in medical students and doctors has been unavailable . OBJECTIVE To examine changes in empathy among medical students as they progress through medical school . MATERIAL S AND SUBJECTS A newly developed scale ( Jefferson Scale of Physician Empathy [ JSPE ] , with 20 Likert-type items ) was administered to 125 medical students at the beginning ( pretest ) and end ( post-test ) of Year 3 of medical school . This scale was specifically developed for measuring empathy in patient care situations and has acceptable psychometric properties . METHODS In this prospect i ve longitudinal study , the changes in pretest/post-test empathy scores were examined by using t-test for repeated measure design ; the effect size estimates were also calculated . RESULTS Statistically significant declines were observed in 5 items ( P < 0.01 ) and the total sores of the JSPE ( P < 0.05 ) between the 2 test administrations . CONCLUSIONS Although the decline in empathy was not clinical ly important for all of the statistically significant findings , the downward trend suggests that empathy could be amenable to change during medical school . Further research is needed to identify factors that contribute to changes in empathy and to examine whether targeted educational programmes can help to retain , reinforce and cultivate empathy among medical students for improving clinical outcomes Background Effective doctor-patient communication has been linked to numerous benefits for both patient and physician . The purpose of this study was to evaluate the effectiveness of the University of Toronto 's Therapeutic Communication Program ( TCom ) at improving first-year medical students ' communication skills . Methods Data were collected during the 1996/97 , 1997/98 , 1998/99 and 1999/00 academic years . The study used a repeated measures design with a waiting list control group : students were r and omly assigned to groups starting the educational intervention in either September ( N = 38 ) or February ( N = 41 ) , with the latter being used as a control for the former . Communication skills were assessed at the pre- and post-intervention times and at the end of the academic year from the perspectives of student , st and ardized patient and external rater . Results Only the external rater , using an instrument design ed to assess the students ' empathy based on their written responses , showed a time × group interaction effect ( p = 0.039 ) , thereby partially supporting the hypothesis that TCom improved the students ' communication skills . Students rated themselves less positively after participation in the program ( p = 0.038 ) , suggesting that self-evaluation was an ineffective measure of actual performance or that the program helped them learn to more accurately assess their abilities . Conclusion The lack of strong findings may be partly due to the study 's small sample sizes . Further research at other medical or professional schools could assess the effectiveness of similar courses on students ' communication skills and on other capacities that were not measured in this study , such as their underst and ing of and comfort with patients , their management of the doctor-patient relationship , and their ability to give and receive feedback BACKGROUND Empathy is critical to the development of professionalism in medical students , and the humanities-particularly literature -have been touted as an effective tool for increasing student empathy . This quantitative/qualitative study was undertaken to assess whether reading and discussing poetry and prose related to patients and doctors could significantly increase medical student empathy and appreciation of the relevance of the humanities for their own professional development . METHOD In 2000 - 2001 , first year students ( n=22 ) volunteered for an eight-session literature and medicine elective  and were r and omly assigned to either immediate participation in the class or a wait-list group , who participated in the same class 6 months later . Complete pre- and post-intervention data for 16 students from both groups were obtained for two quantitative measures of empathy and an attitudes-toward-the-humanities scale . Students also participated in a qualitative group interview pre- and post-intervention . RESULTS Empathy and attitudes toward the humanities improved significantly ( p<0.01 ) after participation in the class when both groups of students were combined . The scaled treatment effect size was in the moderate range ( > or = 0.60 st and ard deviation units ) for both measures that had statistically significant pre-to-post changes . Furthermore , student underst and ing of the patient 's perspective became more detailed and complex after the intervention . Students were also more likely post-intervention to note ways reading literature could help them cope with training-related stress . CONCLUSION A brief literature -based course can contribute to greater student empathy and appreciation for the value of humanities in medical education OBJECTIVE Literature indicates a decline in patient-centredness in medical students , especially during clinical clerkships . We examined the impact of pre clinical communication skills training ( CST ) on students ' development of patient-centred attitudes and attitudes toward CST during clerkships . METHODS We prospect ively compared two cohorts before and after clerkships : one cohort ( n=48 ) had not received CST , whereas the other ( n=37 ) had received a five-year CST .  We assessed the impact using five vali date d question naires . RESULTS Communication trained students slightly but significantly declined in patient-centred attitudes ( 3/4 scales ) and attitudes toward CST during clerkships , whereas the scores of the untrained students remained stable ( 5/5 scales ) . Both cohorts did not differ in attitudes before clerkships . In the trained cohort , males mostly showed a sharper decline than females . In the total group ( n=85 ) , females demonstrated higher attitude scores toward CST , and in 1/4 scales measuring patient-centred attitudes . CONCLUSION This cohort study suggests that CST might make students more vulnerable to decline in attitude scores during clerkships . PRACTICE IMPLICATION S These remarkable findings , contrary to what educators would expect to result from their efforts , challenge medical education to address the new questions that are raised about the validity of the question naires , the impact of CST and the learning processes involved in the development of patient-centredness Objective The authors address the issue of cultivating medical students ’ empathy for the mentally ill by examining medical student empathy pre- and postsimulated auditory hallucination experience . Methods At the University of Utah , 150 medical students participated in this study during their 6-week psychiatry rotation . The Jefferson Scale of Physician Empathy , Student Version , was used before and after the experience . The auditory hallucinations were provided as part of the “ Hearing Voices That Are Distressing ” curriculum created by the National Empowerment Center , which attempted to simulate the experience of hearing auditory hallucinations . While the students were listening to the auditory hallucinations , they underwent a psychiatric interview and simplified cognitive testing and were asked to socially interact in the community . We conducted a paired sample t-test of significance to identify pre- and postsimulated auditory hallucination changes in medical student empathy . Fifty students were r and omly selected to serve as a comparison group . Results The paired sample t-test revealed that after listening to the simulated auditory hallucinations and participating in the simplified neurocognitive testing , the students ’ empathy score increased . Students in the comparison group had no significant difference in their empathy scores . Conclusion These results suggest that empathy may increase when students are given a brief glimpse into the mind of a mentally ill patient by listening to simulated auditory hallucinations . Specific interventions to increase empathy for the mentally ill can lead to a better underst and ing of how empathy can improve patient care , enhance the doctor-patient relationship , and direct future educational strategies 
    Output:
    
These findings suggest that educational interventions can be effective in maintaining and enhancing  empathy in undergraduate medical students .