***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 To provide patient-centred holistic care , doctors must possess good interpersonal and empathic skills . Medical schools traditionally adopt a skills-based approach to such training but creative engagement with the arts has also been effective . A novel arts-based approach may help medical students develop empathic underst and ing of patients and thus contribute to medical students ’ transformative process into compassionate doctors . This study aim ed to evaluate the impact of an arts-making workshop on medical student empathy . Methods This was a mixed- method quantitative-qualitative study . In the 2011–12 academic year , all 161 third year medical students at the University of Hong Kong were r and omly allocated into either an arts-making workshop or a problem-solving workshop during the Family Medicine clerkship according to a central ly-set timetable . Students in the arts-making workshop wrote a poem , created artwork and completed a reflective essay while students in the conventional workshop problem-solved clinical cases and wrote a case commentary . All students who agreed to participate in the study completed a measure of empathy for medical students , the Jefferson Scale of Empathy ( JSE ) ( student version ) , at the start and end of the clerkship . Quantitative data analysis : Paired t-test and repeated measures ANOVA was used to compare the change within and between groups respectively . Qualitative data analysis : Two research ers independently chose representational narratives based on criteria adapted from art therapy . The final 20 works were agreed upon by consensus and thematically analysed using a grounded theory approach . Results The level of empathy declined in both groups over time , but with no statistically significant differences between groups . For JSE items relating to emotional influence on medical decision making , participants in the arts-making workshop changed more than those in the problem-solving workshop . From the qualitative data , students perceived benefits in arts-making , and gained underst and ing in relation to self , patients , pain and suffering , and the role of the doctor . Conclusions Though quantitative findings showed little difference in empathy between groups , arts-making workshop participants gained empathic underst and ing in four different thematic areas . This workshop also seemed to promote greater self-awareness which may help medical students recognize the potential for emotions to sway judgment . Future art workshops should focus on emotional awareness and regulation BACKGROUND AND PURPOSE Optimizing communication between radiotherapy team members and patients and between colleagues requires training . This study applies a r and omized controlled design to assess the efficacy of a 38-h communication skills training program . MATERIAL AND METHODS Four radiotherapy teams were r and omly assigned either to a training program or to a waiting list . Team members ' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient were the primary endpoints . These encounters were scheduled at the baseline and after training for the training group , and at the baseline and four months later for the waiting list group . Encounters were audiotaped and transcribed . Transcripts were analyzed with content analysis software ( LaComm ) and by an independent rater . RESULTS Eighty team members were included in the study . Compared to untrained team members , trained team members used more turns of speech with content oriented toward available re sources in the team ( relative rate [RR]=1.38 ; p=0.023 ) , more assessment utterances ( RR=1.69 ; p<0.001 ) , more empathy ( RR=4.05 ; p=0.037 ) , more negotiation ( RR=2.34 ; p=0.021 ) and more emotional words ( RR=1.32 ; p=0.030 ) , and their self-efficacy to communicate increased ( p=0.024 and p=0.008 , respectively ) . CONCLUSIONS The training program was effective in improving team members ' communication skills and their self-efficacy to communicate in the context of an encounter with a simulated patient . Future study should assess the effect of this training program on communication with actual patients and their satisfaction . Moreover a cost-benefit analysis is needed , before implementing such an intensive training program on a broader scale Introduction Physician empathy is a complex phenomenon known to improve illness outcomes ; however , few tools are available for deliberate practice of empathy . We used a virtual patient ( VP ) to teach empathic communication to first-year medical students . We then evaluated students ’ verbal empathy in a st and ardized patient ( SP ) interaction . Methods Seventy medical students , r and omly assigned to 3 separate study groups , interacted with ( 1 ) a control VP portraying depression , ( 2 ) a VP with a backstory simulating patient shadowing , or ( 3 ) a VP able to give immediate feedback about empathic communication ( empathy-feedback VP ) . Subsequently , the students interviewed an SP portraying a scenario that included opportunities to express empathy . All SP interviews were recorded and transcribed . The study outcomes were ( 1 ) the students ’ verbal response to the empathic opportunities presented by the SP , as coded by reliable assessors using the Empathic Communication Coding System , and ( 2 ) the students ’ responses as coded by the SPs , using a communication checklist . Results There were no significant differences in student demographics between groups . The students who interacted with the empathy-feedback VP showed higher empathy in the SP interview than did the students in the backstory VP and the control VP groups [ mean ( SD ) empathy scores coded on a 0–6 scale were 2.91 ( 0.16 ) vs. 2.20 ( 0.22 ) and 2.27 ( 0.21 ) , respectively ) . The difference in scores was significant only for the empathy-feedback VP versus the backstory VP group ( P = 0.027 ) . The SPs rated the empathy-feedback and the backstory VP groups significantly higher than the control VP group on offering empathic statements ( P < 0.0001 ) , appearing warm and caring ( P = 0.015 ) , and forming rapport ( P = 0.004 ) . Conclusions Feedback on empathy in a VP interaction increased students ’ empathy in encounters with SPs , as rated by trained assessors , whereas a simulation of patient shadowing did not . Both VP interventions increased students ’ empathy as rated by SPs , compared with the control VP group PURPOSE To use a st and ardized videotape stimulus to assess the effect of physician compassion on viewers ' anxiety , information recall , treatment decisions , and assessment of physician characteristics . PARTICIPANTS AND METHODS One hundred twenty-three healthy female breast cancer survivors and 87 women without cancer were recruited for this study . A r and omized pretest/posttest control group design with a st and ardized videotape intervention was used . Participants completed the State-Trait Anxiety Inventory ( STAI ) , an information recall test , a compassion rating , and physician attribute rating scales . RESULTS Women who saw an " enhanced compassion " videotape rated the physician as warmer and more caring , sensitive , and compassionate than did women who watched the " st and ard " videotape . Women who saw the enhanced compassion videotape were significantly less anxious after watching it than the women in the other group . Nevertheless , information recall was relatively low for both groups , and enhanced compassion did not influence patient decisions . Those who saw the enhanced compassion videotape rated the doctor significantly higher on other positive attributes , such as wanting what was best for the patient and encouraging the patient 's questions and involvement in decisions . CONCLUSION The enhanced compassion segment was short , simple , and effective in decreasing viewers ' anxiety . Further research is needed to translate these findings to the clinical setting , where reducing patient anxiety is a therapeutic goal CONTEXT Medical errors are associated with feelings of distress in physicians , but little is known about the magnitude and direction of these associations . OBJECTIVE To assess the frequency of self-perceived medical errors among resident physicians and to determine the association of self-perceived medical errors with resident quality of life , burnout , depression , and empathy using vali date d metrics . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve longitudinal cohort study of categorical and preliminary internal medicine residents at Mayo Clinic Rochester . Data were provided by 184 ( 84 % ) of 219 eligible residents . Participants began training in the 2003 - 2004 , 2004 - 2005 , and 2005 - 2006 academic years and completed surveys quarterly through May 2006 . Surveys included self- assessment of medical errors and linear analog scale assessment of quality of life every 3 months , and the Maslach Burnout Inventory ( depersonalization , emotional exhaustion , and personal accomplishment ) , Interpersonal Reactivity Index , and a vali date d depression screening tool every 6 months . MAIN OUTCOME MEASURES Frequency of self-perceived medical errors was recorded . Associations of an error with quality of life , burnout , empathy , and symptoms of depression were determined using generalized estimating equations for repeated measures . RESULTS Thirty-four percent of participants reported making at least 1 major medical error during the study period . Making a medical error in the previous 3 months was reported by a mean of 14.7 % of participants at each quarter . Self-perceived medical errors were associated with a subsequent decrease in quality of life ( P = .02 ) and worsened measures in all domains of burnout ( P = .002 for each ) . Self-perceived errors were associated with an odds ratio of screening positive for depression at the subsequent time point of 3.29 ( 95 % confidence interval , 1.90 - 5.64 ) . In addition , increased burnout in all domains and reduced empathy were associated with increased odds of self-perceived error in the following 3 months ( P=.001 , P<.001 , and P=.02 for depersonalization , emotional exhaustion , and lower personal accomplishment , respectively ; P=.02 and P=.01 for emotive and cognitive empathy , respectively ) . CONCLUSIONS Self-perceived medical errors are common among internal medicine residents and are associated with substantial subsequent personal distress . Personal distress and decreased empathy are also associated with increased odds of future self-perceived errors , suggesting that perceived errors and distress may be related in a reciprocal cycle OBJECTIVE To assess the effects of Balint groups on empathy measured by the Consultation And Relational Empathy Measure ( CARE ) scale rated by st and ardized patients during objective structured clinical examination and self-rated Jefferson 's School Empathy Scale - Medical Student ( JSPE-MS © ) among fourth-year medical students . METHODS A two-site r and omized controlled trial were planned , from October 2015 to December 2015 at Paris Diderot and Paris Descartes University , France . Eligible students were fourth-year students who gave their consent to participate . Participants were allocated in equal proportion to the intervention group or to the control group . Participants in the intervention group received a training of 7 sessions of 1.5-hour Balint groups , over 3months . The main outcomes were CARE and the JSPE-MS © scores at follow-up . RESULTS Data from 299 out of 352 r and omized participants were analyzed : 155 in the intervention group and 144 in the control group , with no differences in baseline measures . There was no significant difference in CARE score at follow-up between the two groups ( P=0.49 ) . The intervention group displayed significantly higher JSPE-MS © score at follow-up than the control group [ Mean ( SD ) : 111.9 ( 10.6 ) versus 107.7 ( 12.7 ) , P=0.002 ] . The JSPE-MS © score increased from baseline to follow-up in the intervention group , whereas it decreased in the control group [ 1.5 ( 9.1 ) versus -1.8 ( 10.8 ) , P=0.006 ] . CONCLUSIONS Balint groups may contribute to promote clinical empathy among medical students . TRIAL REGISTRATION NCT02681380 Empathy is an essential attribute for medical professionals . Yet , evidence 
    Output:
    
We identified the following key behaviors to be effective : ( 1 ) sitting ( versus st and ing ) during the interview ; ( 2 ) detecting patients ' non-verbal cues of emotion ; ( 3 ) recognizing and responding to opportunities for compassion ; ( 4 ) non-verbal communication of caring ( e.g. eye contact ) ; and ( 5 ) verbal statements of acknowledgement , validation , and support .
These behaviors were found to improve patient perception of physician empathy and /or compassion .
CONCLUSION Evidence suggests that training can enhance physician empathy and compassion .