***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: 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 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 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 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 BACKGROUND Doctors ' communication with patients is commonly hampered by lack of training in this core skill . This study aim ed to assess the efficacy of an intensive 3-day training course on communication skills in a r and omised controlled trial with a two-by-two factorial design and several outcomes . METHODS 160 oncologists from 34 UK cancer centres were r and omly allocated to four groups : written feedback followed by course ; course alone ; written feedback alone ; and control . At each of two assessment periods , consultations with six to ten consecutive , consenting patients per doctor were videotaped . 2407 patients participated . Outcome measures included objective and subjective ratings made by research ers , doctors , and patients . The primary outcomes were objective improvements after the intervention in key communication skills . Course content included structured feedback , videotape review of consultations , role-play with simulated patients , interactive group demonstrations , and discussion led by a trained facilitator . FINDINGS In Poisson regression analysis of counts of communication behaviours , course attendance significantly improved key outcomes . The estimated effect sizes corresponded to higher rates of use of focused questions ( difference between course attenders [ n=80 ] and non-attenders [ n=80 ] 34 % , p=0.003 ) , focused and open questions ( 27 % , p=0.005 ) , expressions of empathy ( 69 % , p=0.003 ) , and appropriate responses to patients ' cues ( 38 % , p=0.026 ) , and a 24 % lower rate of use of leading questions ( p=0.11 ) . There was little evidence for the effectiveness of written feedback . INTERPRETATION The communication problems of senior doctors working in cancer medicine are not resolved by time and clinical experience . This trial shows that training courses significantly improve key communication skills . More re sources should be allocated to address doctors ' training needs in this vital area Medical education faces increasing criticism because of the perception that it is difficult to produce physicians who are both technically competent and compassionate . One approach to addressing this problem is to train physicians to address the emotional concerns that patients experience as a result of their medical problems . Results of the authors ' r and omized , controlled experiment in training medical students to respond to patients ' emotional concerns provide evidence of the efficacy and feasibility of such training . Only students who received small-group instruction  in addition to large-group lectures  exhibited statistically significant ( p less than .001 ) improvement in their ability to respond to the emotional concerns of patients in hypothetical cases . The students who received only the lectures exhibited significant improvement ( p less than .001 ) in their preference for responses that addressed patients ' emotional concerns but not in their responses to written , hypothetical patient cases . Even though these students ' preferences for responses to emotional concerns on the average did increase significantly , the preferences were significantly ( p less than .001 ) less favorable than the preferences of the students who received small-group instruction . The small group instruction consisted of both interviews with elderly nursing home residents , who served as simulated patients , and structured practice and review sessions Summary Practitioner empathy and patient enablement at a " contact " consultation were retrospectively associated with changes in main complaint and well-being , in a cross-sectional study of out- patients attending the Glasgow Homoeopathic Hospital .  Patient expectation , relational continuity , and duration of attendance at the hospital were also correlated with perceived change in health outcome in univariate analysis . However , multi-regression analysis suggested three major independent variables associated with health outcome – empathy , enablement , and duration of attendance . Health outcomes were then measured in the same cohort 12 months after " contact " consultation . Both univariate and multivariate analysis indicated that the only significant predictive factor in health change over the 12-month period was patient enablement score at contact consultation . This study demonstrates the importance of prospect i ve studies in assessing potentially causal relationships between consultation quality and health outcomes and suggests a key role for patient enablement . ZusammenfassungIn einer Querschnittsstudie wurden ärztliche Empathie und Patienten-"Enablement " bei ambulanter Erstkonsultation am Glasgow Homeopathic Hospital retrospektiv auf ihre Auswirkung auf Hauptbeschwerden und Wohlbefinden untersucht . Die Erwartung der Patienten , Kontinuität der Betreuung und Dauer der Betreuung wurden ebenso mit Änderungen i m Befinden korreliert . In der Multiregressionsanalyse sind 3 wesentliche unabhängige Faktoren mit dem Outcome assoziiert – Empathie , Enablement und Betreuungsdauer . Outcome -Parameter wurden anschließend in der gleichen Kohorte 12 Monate nach Erstkonsultation untersucht . Sowohl in der univariaten als auch der multivariaten Analyse war der einzige Faktor mit signifikanter Auswirkung auf das Outcome nach 12 Monaten der Patienten-"Enablement"-Score bei Erstkonsultation . Die Studie zeigt die Wichtigkeit prospektiver Untersuchungen , um kausale Zusammenhänge zwischen der Qualität einer Konsultation und dem Outcome zu erfassen , und legt eine Schlüsselrolle für den Faktor Patienten-"Enablement " nahe OBJECTIVE To relate prospect ively initial consultation characteristics-length , empathy , and patient enablement- with perceived health changes in patients going to the Glasgow Homoeopathic Hospital ( GHH ) . METHODS Consecutive out patients completed the  Consultation and Relational Empathy ( CARE ) measure and the Patient Enablement Instrument ( PEI ) immediately after their first consultations , again at 3 months , and the PEI also at 12 months . The Short Form-12 was completed immediately before and the Measure Yourself Medical Outcome ( MYMOP ) Profile during the first consultation , and both were repeated at 3 and 12 months . Perceived changes in main complaint and well-being were assessed using the Glasgow Homoeopathic Outcome Scale ( GHHOS ) . RESULTS Empathy score at first consultation was highly predictive of ongoing empathy score at 3 months ( Spearman 's rho , 0.572 , p < 0.0001 ) . Empathy scores at first consultation also correlated significantly with enablement score at first consultation ( rho , 0.325 , p < 0.0001 ) and overall enablement at 12 months ( rho , 0.281 ; p < 0.05 ) . Controlling for the number of subsequent consultations , initial empathy scores were also predictive of change in main complaint , and general well-being , at 3 months ( rho , 0.225 , 0.213 respectively ; p < 0.05 ) . Enablement score at first consultation also predicted overall enablement at 3 months ( rho , 0.255 ; p < 0.05 ) and 12 months ( rho , 0.282 ; p < 0.05 ) . Initial enablement predicted GHOSS well-being score at 3 months after controlling for number of consultations ( rho , 0.279 ; p < 0.05 ) . Both empathy and enablement at 3 months predicted overall enablement at 12 months ( rho , 0.327 ; p < 0.01 and rho , 0.577 ; p < 0.0001 , respectively ) . Empathy at 3 months was not significantly related to GHHOS scores at 12 months , whereas enablement scores at 3 months were highly predictive of both GHHOS main complaint and well-being scores at 12 months ( rho , 0.459 and 0.50 
    Output:
    
Conclusion A number of empathy measures available have been psychometrically assessed for research use among medical students and practising medical doctors .
No empathy measures were found with sufficient evidence of predictive validity for use as selection measures for medical school .