The EEG Physiological Mechanism Of The Improvement Of Simulation-based Medical Education On Empathy Ability Of Medical Masters

Background: With the establishment of the bio-psycho-social and patient-centered medical thinking mode,the reform of the third generation of medical education oriented by clinical competence has been promoted in the world,and modern medical education has put forward new requirements for the humanistic quality of medical students.Empathy is the mental process by which an individual perceives or imagines the emotions of another and partially experiences the feelings of another.In the field of clinical medicine,empathy is defined as the doctor’s ability to accurately understand the needs of the patient,care for the patient’s suffering,and understand the patient’s situation.In medical education,it is very important to enhance the empathy ability of medical students.Many studies at home and abroad have found that the empathy ability of medical undergraduates does not improve in the course of clinical undergraduate study,and even shows a downward trend.These studies indicate that current medical education may not be able to continuously improve the empathy ability of medical undergraduates,and there is a lack of serial studies on medical professionals at other stages.Some studies have shown that empathic intervention through medical humanistic education such as situational simulation teaching may be effective.Most studies in this field adopt the form of questionnaire,and there are no reports on the physiological mechanism of brain,which limits the in-depth understanding of this field and the improvement of practice.Objective: The changing trend of empathy ability of medical professionals at different stages was explored through a large sample survey in order to provide basis for setting up corresponding targeted courses.The Event-Related Potential(ERP)technique was used to compare the effects of pain empathic stimuli in medical and non-medical situations on their empathic ability and brain mechanism.Focusing on the empathy ability of clinical medical graduate students,the differences of empathy ability before and after situational simulation teaching and the changes of brain mechanism during empathy processing were studied.Methods: A total of 883 people from the First Affiliated Hospital of Dalian Medical University at different career stages were selected for questionnaire survey.The personnel levels included: junior undergraduates,senior undergraduates,professional master students,resident physicians,attending physicians,associate chief physicians and chief physicians.The survey included general data,interpersonal indicator scale,emotional intelligence scale and interpersonal trust scale.Twenty-five clinical masters from the First Affiliated Hospital of Dalian Medical University were recruited for the baseline EEG experiment of empathy ability.The subjects rated the cognitive and emotional empathy of pain pictures or non-pain pictures in different situations in the pain empathy paradigm and filled in the Jefferson Empathy Scale.After 6 months of situational simulation teaching for 25 clinical masters participating in the baseline EEG experiment,14 students with qualified class attendance were selected to test their empathy ability again,including Jefferson Empathy Scale,pain empathy paradigm and EEG records,which were consistent with the baseline period.Results: A large sample survey found that there were significant differences in empathy and emotional intelligence among medical professionals at different stages.Chief physicians’ total score of empathy,total score of emotional intelligence and its subcomponent opinion selection,imagination,empathic concern,self-emotion analysis and expression and emotion use were significantly higher than those in other stages.In the baseline EEG experiment of clinical master’s degree,behavioral results showed that the main effect of pain or not was significant,and the empathy score of pain pictures was significantly higher than that of non-pain pictures.The main effect of picture situation was significant,and the empathy score of medical situation picture was significantly higher than that of non-medical situation picture.The interaction between pain and picture situation was significant.There was no difference in empathy score between the two situations in the non-pain pictures,while the empathy score in the medical situation was higher in the pain pictures.ERP results showed that P2 in central parietal lobe showed the main effect of picture situation,and the amplitude of medical situation picture was larger,and the amplitude was significantly correlated with empathy score.The amplitude of late positive potential(LPP)induced by pain stimulus was higher in posterior parietal lobe,and the amplitude was significantly correlated with empathy score.In the postintervention EEG experiment,behavioral results showed that the total score of the Jefferson Empathy Scale and its sub-component scores were significantly higher than the baseline scores.The main effect of situational simulation teaching was significant,and the empathy score after intervention was significantly higher than that in the baseline period.The main effect of picture type was significant,and the empathy score of pain pictures was significantly higher than that of non-pain pictures.ERP results showed that the main effect of situational simulation teaching was significant,and the average amplitude of LPP in posterior parietal lobe after intervention was significantly higher than that in baseline period.The main effect of image type was significant,and the average amplitude induced by pain images was significantly greater than that of non-pain images.Conclusion: 1.Medical students and junior doctors generally face the problem of improving professional skills but lagging the development of empathy.The effect of medical humanistic education is not obvious in the learning stage,so it is extremely urgent and necessary to conduct targeted empathy training for clinical masters.2.Clinical master students show higher empathy sensitivity to picture stimuli in medical background,which is reflected in higher scores of cognitive empathy and affective empathy in pain pictures,and larger amplitude of P2.Professional postgraduates do not lack empathy on the level of neurophysiological function,and medical situations under experimental conditions can induce a higher level of empathy.3.Situational simulation teaching can improve the empathic ability of clinical masters,and the change of their empathic ability can cause changes in the electrophysiological mechanism of brain,which will increase the favorable electrophysiological evidence of the physiological mechanism of empathic plasticity.