A Study of the Consultation and Relational Empathy (CARE) Measure for Medical Students

  • Nashwan Nemat Hanna Alnoman

    Student thesis: Doctoral ThesisDoctor of Medicine


    Patients who are treated empathically tend to be more satisfied and have better health outcomes. Many instruments for measuring empathy in different health contexts have been developed for postgraduate and to a lesser extent undergraduate health professional use. This thesis presents the results of three studies. The first is a systematic review of the literature describing empathy measures for use in the health professional context. The review was conducted to find the best measure specifically designed for and evaluated in the clinical context that assessed empathy reliably and preferably from a patient perspective. The Consultation and Relational Empathy (CARE) measure was selected from the 12 potential empathy measures available. This instrument was developed and tested in general practice consultations in Scotland, and its usefulness for assessing physicians’ empathy has been demonstrated.
    The second study, which forms the main research component of the thesis, is an evaluation of the utility of the CARE measure in assessing medical undergraduates on general practice placements. This study aimed to establish whether the CARE measure offers a reliable, valid, and practical means of assessing certain aspects of senior clinical medical students’ consultation skills. Fifth-year students who performed a two- or three-month GP attachment in academic years 2009–2010, 2010–2011, and 2011– 2012 were invited to participate. In 2011 participation in the study became a course requirement. Consulted patients were invited to complete a modified CARE questionnaire ‘on the student’. The form initially included 11 questions answered on a five -point scale; from the academic year 2010–2011, the form also included a free-text comment option. Patients completed questionnaires anonymously. Forms were collated
    and forwarded to the principle investigator. A minimum of 25 forms were required for each student in order to minimise potential selection bias in the analysis.
    In the first year of the study the response rate was 56 %. During the next two academic years, this rate improved to over 95%. The total number of the CARE measure forms returned was 2,145, with 1,808 adequately completed. The average score of the students recruited was 4.57 (standard deviation = 0.19), which is higher than average scores for general practitioners. Generalisability theory calculations showed that the CARE measure had high internal consistency, with 25 patients per student delivering an overall reliability coefficient of 0.74. Using the CARE measure with students significantly correlated at a moderate level with relevant outcome assessments such as the mini-Clinical Evaluation Exercise (mini-CEX), Objective Structured Clinical Examination (OSCE) at the end of the GP block, and tutor scores (r = 0.38, r = 0.33, r = 0.33, respectively; P < 0.05). The findings suggest that the CARE measure is a useful tool for assessing senior medical students’ consultation skills, at least in the context of extended general practice attachments. In addition, the measure provides students with valuable and authentic patient feedback for their training.
    The third study was a ‘mapping exercise’ designed to establish the role of current assessment tools at the University of Dundee in relation to Tomorrow’s Doctors outcomes, and specifically where/how CARE might fit in. Dundee medical faculty staff, block leaders, undergraduate medical educators, and others who engaged directly with assessments and with experience of the existing exams were invited to ‘map’ the value of each aspect of the medical school’s 11 assessment tools against General Medical Council (GMC) attributes. Data was collected electronically from 17 staff
    members. The results of the exercise revealed both gaps in assessment and over-testing of specific GMC attributes. These findings offer Dundee Medical School an opportunity to optimise their approach to assessment and achieve a broader coverage of GMC outcomes. Thus, the CARE measure offers a logical extension to aspects of the OSCE assessment.
    The results show that the CARE measure is a feasible, acceptable, reliable, and valid measure for the assessment of students. In addition, as it incorporates authentic patient feedback into training, this measure can offer unique utility to the medical school’s curriculum and assessment as it incorporates the rarely employed patient voice.
    Date of Award2014
    Original languageEnglish
    SponsorsMinistry of Higher Education and Scientific Research
    SupervisorJon Dowell (Supervisor) & Douglas Murphy (Supervisor)


    • Empathy measure
    • Medical students
    • Assessment

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